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General NPI Number Information
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NPI Number | 1780280560
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Entity Type | Organization
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Legal Business Name | OAK HAVEN RESIDENTIAL CARE LLC
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Dates
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Enumeration Date | 12/08/2020
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Last Update Date | 12/08/2020
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Provider Practice Location Address
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Address Line | 152 MAIN ST
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City | CLOVERDALE
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State | OH
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Zip | 45827-9778
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Country | US
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Telephone | 419-488-2310
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Fax | 419-488-2321
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Provider Business Mailing Address
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Address Line | PO BOX 86
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City | CLOVERDALE
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State | OH
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Zip | 45827-0086
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Country | US
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Telephone | 419-488-2310
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Fax | 419-488-2321
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. SHERRY KAYE WEBB
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Credential | LPN
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Telephone | 419-615-3357
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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